Patient FIRST: Infection prevention and control

Page last updated: 8 September 2023
Categories
Organisations we regulate
  1. Introduction
  2. Flow
  3. Infection prevention and control
  4. Reduced patients in emergency departments
  5. Staffing
  6. Treatment
  7. Appendices

Aim

No patient or staff member will acquire a nosocomial infection as a result of their time in the emergency department.

Background

From our inspection activity we know that good infection control improves the quality of care and outcomes for people. We know that COVID-19 changed the way emergency departments operated. However we need to move back to core infection, prevention and control procedures.

NHS England sets out 10 elements of standard infection control precautions (SICPs):

  1. patient placement/assessment of infection risk
  2. hand hygiene
  3. respiratory and cough hygiene
  4. personal protective equipment
  5. safe management of the care environment
  6. safe management of care equipment
  7. safe management of healthcare linen
  8. safe management of blood and body fluids
  9. safe disposal of waste (including sharps)
  10. occupational safety/managing prevention of exposure (including sharps)

Other measures adopted at the height of the pandemic that remain important are:

  • general assessment and screening of high-risk infected patients across the range of infectious diseases
  • appropriate isolation areas and facilities for all patients presenting with infections - for example, diarrhoea and vomiting, COVID-19, Ebola and Mpox
  • protecting those that are vulnerable to infections - for example, people who are neutropenic or immunocompromised.

There is likely to be a need for structural reviews of departments to include:

  • isolation areas
    • resuscitation room
    • other clinical areas, for example majors, minors, urgent treatment centre, paediatrics
  • dedicated areas where aerosol generating procedures (AGPs) can be delivered safely
  • areas for applying appropriate PPE based on infection risk and local and national guidance.

In good emergency departments we have seen

  • good engagement with trust's infection prevention and control (IPC) leads
  • adherence to local and national IPC best guidance practice, such as RCEM, NHS England and CQC
  • good compliance with mandatory training for IPC
  • observation in the workplace of up-to-date IPC processes and procedures following local and national policies - for example, hand washing, correct use of PPE and recognition of infectious patients
  • a clear understanding among staff both within and outside the emergency department of appropriate PPE use for those patients who require an AGP
  • appropriate areas for applying the correct PPE based on circumstance
  • cleaning schedule that all staff adhere to
  • access to prompt processes for screening and timely flow out of the urgent care system.
Specific examples of good practice
  1. Early assessment and recognition of assessment to enable isolation and prevent infection spread
  2. Observing good IPC procedures such as hand washing and PPE use
  3. Good uptake and understanding of training relating to IPC issues
  4. Procedures for preventing crowding in waiting rooms in relation to IPC - for example, full capacity protocol

Managing crowding in relation to infection control

Background

Emergency departments frequently:

  • face surges of attendances - these may significantly increase the number of people within the footprint of the emergency department
  • face exit block - patients who need to be admitted remain for extended periods of time within the department
  • have staff within them that come from other departments to review patients - often as a team

In good emergency departments we have seen

  • clear IPC signage relating to current standards
  • methods to reduce the number of patients waiting at any one time
    • choose and book type models of care
    • virtual waiting rooms
  • reduced numbers of staff who were not in the emergency department to review patients
    • limited entrances and exits – the emergency department is not used as a short cut to other areas of the hospital

When considering infection control for children, the processes for assessment, isolation and PPE should be the same as adults. Separate children's emergency department must adhere to local and national guidance regarding children.

Consider making PPE less scary for children. See “Supersuits” by Katie Chappell.

Specific examples of good practice
  1. Appointment based systems. Some groups of patients need urgent and emergency care but can be reviewed via an appointment-based system. This helps reduce peaks and troughs of attendances within the emergency department. Examples include:
    1. patients with minor injuries referred via NHS 111
    2. patients with injuries who self-present after initial review and investigations are completed.

Example datasets that can drive possible safety improvements

  • Nosocomial rates
    • Trusts are able to intelligently monitor nosocomial rates. To do so, it is important to keep patient records that track:
      • locations visited in the department
      • length of time spent in non-admitted areas
      • which members of staff treated or nursed them.
  • Proportion of patients with suspected infection who receive point of care testing for flu and COVID-19
  • Mean time for COVID-19 results
  • Number of isolation cubicles with air exchange capability at least 10-12/min
  • Number of negative pressure rooms
  • Number of cubicles with doors as a proportion of total patient cubicles
  • Proportion of staff fit tested for masks
  • Reporting and monitoring of problems of PPE availability/usage though the incident reporting system
  • Review of incidents reported regarding breaches to safe distancing capacity matrix or triggering of escalation plan.

Next:
Reduced patients in emergency departments

Version history

Updated September 2023

We updated references to infection control procedures that have changed since the height of the COVID-19 pandemic. We also updated other minor references to the pandemic.

Updated October 2021

We held two workshops in 2021 for emergency clinicians and NHS executives. We added suggestions and good practice examples from those events. These updates refer more specifically to the pandemic.

Read more about the workshops we held

Download and print

Patient FIRST (September 2023) (pdf, 338.19kB, English)

Listen

Podcast: Emergency departments responding to COVID-19 - Infection prevention and control

References

COVID-19: infection prevention and control (IPC)

Coronavirus (COVID-19): guidance

Safety alerts

RCEM Safety Flash: Buddy System

RCEM Safety Flash: Communication errors with PPE

RCEM Safety Flash: Salbutamol, peak flow and nebulisation advice during COVID-19

Improvement toolkit

Produced by front line clinicians in response to CQC’s Patient FIRST, this toolkit suggests a framework that NHS trusts can use to monitor and assess their progress in applying good practice principles.

Emergency department good practice improvement toolkit (xlsx, 2.93MB, English)

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